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APPLICATION FOR SANITATION PERMIT Permit No. �I.O.______-_ (Complete in Duplicate) a Da#eIssued �/ ,.�_t1Z/ �dsR —roo-e�2 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. - JOB ADDRESS AND LOCATION_ . Owner's Name__ !4?A� ----. __._4�! l[� ^t.�s ------------------------------- Phone Ao-zL Address- Y LC? / ------ r —------------ Contractor's Name • '';r 4`--- -----------------------•--•------------_-- Phone--,f'lr.'if-:7f"?' Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units ,f_ Npmber of bedrooms' _-&-' Number of'baths ::�___ Lot size .�__ - i -p-g---, _------"___--_ Water Supply: Public system ❑-, Community system ❑ Private Depth to'Water Table AX04. Character of soil to ;'depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan et Previous Application Made: Yes No New Construction: Yes No ❑ - b __T PE .OF INSTALLATION AND SPECIFICATIONS: i No septic tanVor cesspool permitted if public sewer.is.available within 200 feet:) Septic Tank: Distance from nearest well_ �J'�-.Distance from faun afion__/Q',____.Mat rial_____�.___ _ ff�� -^ No. of,com artments_. Size_ n _Li`rLi ui d th, AF-_____--__.Ca aci (4 P --------- p 9 P tY -� Disposal Field: Distance from nearest well---//Q"�_Dist ancaeafPom foundation.__ --------------Distance to nearest lot line______.________ Number of'lines---- -------__y ___ __ Length of each line_. _ ar---:Wid --� th of trench -r� o------ , Type of filter material__-_� - _ Depth of filter material-----r : ____Total length-------------------A'I.. ...... See a e Pit: N'urti�abee of nares# we1f,._ �-_ pistanc f m oundation__= -Q�____.Distance to nearest lot li P 9 ----- ----- p - - Lining 'aterial��1 Size: Diameter-033-404 Depth_.-_ Cesspool: Distance from nearest well____-_______._.Distance frorri foundation- ___ ____.Linin material_n _�.� ... -------------------- 9 -� z :. Diameter - '-= _ _ - Depth .---------- - ._Liquid CapaitY 9als. i Privy:i Distance from-neares#-well-------------- -----------------------------'-_Distance from nearest building ❑ _ r, Distance to nearest'lot,line---------_____ - - ------------- -------------- -------------.--- ---•- Remoideling and/or repairing (describe):-' --------- --------------------L- , -^-::---••-----9' '------•--• --------------•-- -------•--.---------------------------------------•-------------- .. ------------------------ ----------- ------i-----•--- --------------------- ------------- �_:r_________________________ ___________________ ----------- ...-..__.______________-_-.--__-______________»__.._________-_-___-____________-__________-____--__•_______-_•-.__________-___-____ :----------------- ----+�..;; ------- --'......-1 ` --------------------------------------------------- ---------- 1:hereby ce tify that I h e pt aced Phis Ii ion nd that the work will be done in accordance with San Joaquin.County ordinances, Sta ' ules a d regulations o e San Joa Local Health District. i (Signed),---- - -- --- ---- --- -- ----------- --- -- ------ • ----- - ------------•------- 1Contractor) $Y' T°' � --�- !� • - ` ' [Title) 1l _p (Plot plan, showing size of lot, location of system in tela+ion t ells, buildings, et can be placed on reverse side). - 4 F r FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY-------------------------------------- -- ------------------------------ ----- DATE---------- ---------------------- ----------- REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------- DATE ' BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------=-------:--- DATE--------- :A Alterations and/or recommend ations_-------------------------------------------------------------.------------------------------------ E - - I ------------•------------------------------•---------------------- _--------------------------------------------- •--------••--------------- --------------------------•--•-•-------------------------- ----+-----------------•------------------------------•---••----------------------•-•--------------....._-----•--•-----•- . _____________________________________________________________________ -------------_------------------------------------------------- ._.---..------------------------------------� ------------------------------------------ --------------------------------------------------______ ______ __________________________________________ ______ _________________________________________ _____ ___________ FINAL INSPECTION-BY:------- ----- - ------- Date_- ------ --- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M ; Revised W-2100